Shiono H, Kuwahara O, Tani Y, Maeda H, Ohta M, Miyazaki M
Department of Surgery, National Toneyama Hospital, Japan.
Kyobu Geka. 1994 Sep;47(10):789-93; discussion 793-6.
We have used the omental pedicle flap (OPF) method to treat 10 patients with chronic empyema secondary to pulmonary tuberculosis. Since 1987 they included 9 men and one woman ranging from 48 to 70 years in age. Two patients were required re-operation because of residual bronchopleural fistulas, and the additional procedures (muscle plombage and thoracoplasty) performed in order to close residual dead space produced more severe thoracic deformity and pulmonary dysfunction. In our first successful case, complete thoracoplasty combined with the OPF method also produced pulmonary dysfunction. On the other hand, thoracic deformity was avoided in 3 other patients and 4 patients without thoracoplasty showed better pulmonary function postoperatively. A comparison of the re-operated patients with the successful cases highlighted two important points regarding the OPF method. One is the need for firm fixation of the OPF to a fistula. We usually place a muscular pedicle flap over the OPF, and add limited thoracoplasty as necessary. The other important point is the control of infection. Open window thoracostomy before the OPF method is effective in patients with active infection. The OPF method is an effective radical operation for severe empyema even when residual dead space is present, and it can also be applied to patients with poor pulmonary function.
我们采用大网膜蒂皮瓣（OPF）法治疗10例继发于肺结核的慢性脓胸患者。自1987年以来，患者包括9名男性和1名女性，年龄在48至70岁之间。2例患者因残留支气管胸膜瘘需要再次手术，为封闭残留死腔而进行的额外手术（肌充填术和胸廓成形术）导致了更严重的胸廓畸形和肺功能障碍。在我们第一例成功的病例中，完整的胸廓成形术联合OPF法也导致了肺功能障碍。另一方面，其他3例患者避免了胸廓畸形，4例未行胸廓成形术的患者术后肺功能较好。对再次手术患者与成功病例的比较突出了关于OPF法的两个要点。一是需要将OPF牢固固定于瘘口。我们通常在OPF上放置一块肌蒂皮瓣，并根据需要进行有限的胸廓成形术。另一个要点是控制感染。在OPF法之前行开窗胸廓造口术对有活动性感染的患者有效。OPF法即使在存在残留死腔的情况下也是治疗严重脓胸的一种有效的根治性手术，并且也可应用于肺功能差的患者。
